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General NPI Number Information
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NPI Number | 1922302314
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH CARE CHIROPRACTIC & WELLNESS
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 1238 PUERTA DEL SOL STE 1A 1A
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6310
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Country | US
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Telephone | 949-492-7488
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Fax | 949-492-6658
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Provider Business Mailing Address
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Address Line | 1001 AVENIDA PICO SUITE C460
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6957
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Country | US
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Telephone | 949-492-7488
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Fax | 949-492-6658
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. BRADLEY SHAPERO
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Credential | D.C.
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Telephone | 949-492-7488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | CA
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